WASHINGTON -- Hopes of getting health care reform through the Senate look grim.
Democratic leaders suffered a major blow Wednesday when some of their own voted against a Medicare rate bill seen as a test for broader reform.
It's called the "doc fix" -- legislation to increase Medicare payments to doctors with a price tag of $247 billion over the next decade.
It was supposed to be part of the cost of health care.
But in order to bring the health care reform bill in under budget, Democrats simply moved that expense out of health care into another part of the budget, without paying for it.
Republicans called that plan a scam.
"They call it a permanent fix, it's not a permanent fix at all. It doesn't fix anything," Sen. Jon Kyl, R-Ariz., said.
The measure was easily defeated Wednesday.
In a statement, Majority Leader Harry Reid said:
"It is unfortunate that Republicans have again chosen to put politics before the needs of the American people. The Medicare Physician Fairness Act would help ensure that seniors and military families get the care they need by fairly compensating Medicare and TRICARE doctors."
But it wasn't just Republicans -- a dozen Democrats also voted 'No,' and that shows some of the trouble Democrats could have in passing a health care reform bill.
"They lost 12 Democrats, plus Sen. Lieberman on this vote, which means that they don't have the votes to pass this stuff," said Ed Haislmaier with the Heritage Foundation.
If the Democratic leadership has trouble passing this measure, they could have trouble finding the 60 votes they need to consider broader health care reform.
Democratic leaders are already walking a delicate balance trying to get and keep members on board.
That's because some are more concerned about their election less than facing the consequences of not walking in lock step with the party.
Illinois Sen. Roland Burris is just one example.
He says he will not support any bill that does not have a public option.
And Burris may have little motivation to bend for a president and leadership who criticized his appointment by an embattled governor and made it clear they won't back his re-election bid next year.
And in an environment where Americans are super-sensitive and tuned in to the health care debate, Democratic leaders will also have their work cut out for them, convincing more centrists Democrats, facing re-election, to lock arms with the party.
Still, the push is on as negotiations continue behind closed doors.